UTI infection lecture notes Flashcards
UTI definition
Combination of clinical features and the presence of bacteria in the urine
What are infections of the lower tract?
UTI
Cystitis
What is infection of upper tract called?
Pyelonephritis
What is pyuria?
Presence of leucocytes in the urine
Associated with infection
What are the most common pathogens causing UTIs?
E. Coli (more than 50%)
Proteus
Klebsiella
Entercocci
Staph. saprophyticus
Staph aureus
Pseudomonas aeruginosa
Symptoms of upper urinary tract infection
Loin pain
Back/flank pain
Fever
haematuria
What are symptoms of lower urinary tract
Dysuria
Confusion
Diagnosis of UTI
Urine dipstick
MC+S
What will a dipstick / urinalysis look at?
Blood
Protein
pH
Glucose
Ketones
Leucocytes
Nitrates
What different types of urine samples are there?
MSU (midstream urine) - gold standard
CSU (catheter specimen urine)
Clean catch (young children/disabled)
Bag urine
SPA aspirate
Early morning urine (for detecting TB as highest concentration of bacilli)
What is being investigated though microscopy
White blood cells
Red blood cells
Casts
Bacteria
Epithelial cells
What levels of WBCs suggests infection?
> 10^5 wbc/ml
What kinds of infections show high WBCs but no bacteria in urine sample?
TB
Non-culturable organisms:
Candida
mycobacteria
mycoplasma
schistosomiasis
Renal calculi (renal stones)
Neoplasm
Catheter (irritation)
How are UTIs managed?
First line: antibiotics (as narrow spectrum as possible
Nitrofurantoin (not suitable for pregnant ladies)
Patients older than __ should not be treated if they have asymptomatic bacteriuria
65
The newer antibiotics, Fosfomycin is a broad spectrum antibiotic distributed in a sachet which prevents the formation of a component of bacterial ___ ___.
cell wall
What kind of bacteria is staphylococcus saprophyticus? (gram and shape)
Gram positive cocci
True or false: You don’t diptstick catheter samples
True
Already know will be WBCs and antibiotics
Instead send a fresh sample not from bag.
Also don’t do microscopy on catheter sample
How many hours post removal of catheter is a patient at risk of catheter associated UTI?
24
Women should be offered s____ in early pregnancy
screening
True or false: asymptomatic bacteriuria should be treated in pregnant ladies
True
What is pyelonephritis?
Infection of renal parenchyma and soft tissues of renal pelvis/ upper ureter
Patients with pyelonephritis are often ___ depleted
fluid
What is the classic triad of pyelonephritis symptoms?
Loin pain
Fever
Pyuria
What are investigations for pyelonephritis
Abdominal exam:
Tender loin
Renal angle tenderness
PV (pelvic examination, rule out tubal/ovarian/appendix pathology)
Bloods including cultures
USS
MSU (midstream urine)
How do you treat pyelonephritis?
Fluid replacement
IV antibiotics (co-amoxiclav possibly with gentamicin)
Drain obstructed kidney
Catheter
Analgesia
What are characteristics of E. coli
Gram negative bacilli
Lactose fermenting
What are complications of pyelonephritis?
Renal abscess
Emphysematous pyelonephritis (rare gas accumulation in tissues)
